By MATTHEW HOLT

It’s hard to imagine but I may now be in possession of the stupidest letter I’ve ever received from an American health insurance company–-and I’m the guy who got five identical letters on one day from Blue Shield of California telling me that they had changed my primary care doctor when I had initiated the change.

A little backstory.  As those you’ve been following along with my various telenovelas may remember that last year I was diagnosed with a failing heart valve.  I also have a failing left knee due mostly to snowboarding into a tree 24 years ago.

I was attempting to put off doing anything about the heart valve for as long as possible because it sounds painful and unpleasant, and I was hoping that I could go ahead with a knee replacement so that my snowboarding can continue apace. My doctors are at UC San Francisco and they agreed that I should have the knee replacement on July 6th, assuming that my heart valve had not got much worse. On June 16th I went into UCSF for a bunch of knee replacement pre-workup and they also checked my heart.

However, my new insurance company, thanks to my wife’s new job, is Cigna. Those of you in California may know that Cigna was having a big dispute with the University of California Health system and that its contract with them was due to expire on June the 30th of this year. Why a health plan and a big provider organization have contracts that expire in the middle of the year when the employers and people who use the health plan network buy them on an annual basis starting in January I don’t know –  and it’s ridiculously stupid. But let’s not get distracted cause I’m not talking about that here!

Because of the fact that they’d be out of network, the ortho team made the obvious suggestion that I move the knee replacement a little earlier, In fact it was planned for June the 22nd. This did not upset me too much as you may have seen that some corrupt Italians have organized a soccer tournament that would give me plenty of games on TV to be entertained by while I was lying around recovering.

Sadly one of the pretests I had on June 16th was an echocardiogram that indicated that my heart valve was in even worse shape than it had been earlier in the year.  After quite a lot of back and forth between the cardiac team, the knee team and the anesthesia team, everyone agreed to put off the knee surgery until we figured out my heart.

Meanwhile sometime late on Thursday the 25th or early on Friday the 26th of June, UC Health and Cigna stepped back from the brink and came to an agreement that will continue the UC system being in Cigna’s network.

Which all brings me to July 6th when I received a letter from Cigna

This is the one that contains more stupidity per square inch than any other communication I’ve had from an insurance company.

First things first; Cigna has a semi-decent website which I have accessed on many occasions. Cigna knows my email. Cigna knows my phone number and also that I can receive a text from them. 

The letter was dated June 25th but I received no email, no text, no carrier pigeon message on that date. And if you go to the messages section of the website which I’ve copied for you below you’ll see that the only communication they have sent me shows that I can get a good deal on joining a fitness club. Although sadly the local one I use isn’t in this deal….

So we’ve established they could have communicated with me on June 25th but instead I received their letter on July 6th.

What did the letter say?

Well to be helpful I have scanned a version of it for you below

The first incredibly stupid thing is that they sent me a letter.  This cost them presumably rather more than sending an email or a text and it also arrived after the period discussed in the letter had ended.

The next incredibly stupid thing is that they told me that UCSF was not in their Network on 6/25/2026.  This is wrong. Even under the contract that was about to expire UCSF was in Cigna’s Network on 6/25/2026 and was going to be for another 4 days. 

Now I’m not sure if the next incredibly stupid thing was Cigna’s fault or UCSF’s.  Apparently UCSF had requested Cigna to cover the surgery I need, which is an aortic valve replacement and by the way involves me being on a heart-lung machine which doesn’t sound like a lot of fun.

But what’s incredibly stupid is that the approved effective dates for this were June 30 through July the 4th. Now there are two things worth knowing about here.  Even though it was probably still the case that on June 25th when this letter was written UCSF was about to be kicked out of the Cigna Network on July 1st,  on June 30th they still were in the network. So for the letter for say they were out of network when it was written was wrong. And as it turns out UCSF is still in the network now.

The second incredibly stupid thing is that at no stage did I have scheduled or planned to have surgery in those few days (June 30-July 4) for which this approval was effective.  I’m also pretty certain that no one at UCSF thought I was going to have surgery on that date mostly because on June 30th I actually had a coronary angiogram as continued prep for the surgery. A surgery planned for a date to be named later this summer. The angiogram was not the procedure mentioned in this letter.

Finally, although Cigna has approved this procedure, albeit for a date on which it was never going to happen, they approved it at an out of network rate, and stated that there was a maximum amount that they will pay. Very helpfully on the second page of the letter it says that “I may be able to save money by seeing a health care provider who is in my network” and “to see a list of these professionals I should look at the Cigna website”.  It then scolds me by telling me that I chose a health professional who isn’t in the network. Of course they’re not telling me how much they are going to pay or how much less I would pay out of pocket if I went to an in-network provider. 

Except of course I already was and now am doing exactly that.

So to sum up. 

• Cigna sent me a letter that took 11 days to get to me as opposed to sending an email or text. 
• The information in the letter was incorrect regarding Cigna’s provider network
• The period for which it approved the requested procedure was also incorrect
•  And that period ended 2 days before I got the letter

I guess we should congratulate them on getting the procedure roughly correct

It would be churlish for me to point out that Cigna’s CEO David Cordani got paid $23 million dollars last year. I can only assume the Cigna board compensation committee was not rewarding him based on the level of accuracy of the customer service his company provided. On the other hand it’s not clear what necessary services his company or its health insurance competitors actually do provide.

And it would be equally churlish for me to point out that no one else in the world outside of the US has to deal with this.

Matthew Holt is publisher and author of THCB